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These intra-epidermal cavities result from areas of laser-induced optical breakdown (LIOB). This injury is most consistent with a localized plasma formation in the epidermis initiated by the melanin absorption of the high energy picosecond light. It appears that treatments with this device and optic result in improvements in dyspigmentation and acne scars with new collagen, elastic tissue, and mucin. The production of this LIOB could directly stimulate an epidermal repair mechanism that results in these clinical findings. Lasers Surg. Med. 48:646-652, 2016. © 2016 Wiley Periodicals, Inc.

Background and Objectives: This study was performed to better understand the cutaneous effects of using a fractional picosecond laser at 755 nm with a diffractive lens array and a picosecond Nd:YAG laser at 532 mn and 1,064 nm with a holographic optic. We characterized the injuries created by these devices on skin clinically and histologically over 24 hours. With this information we modeled the effects of these devices on a cutaneous target. Methods: Eight patients, representing Fitzpatrick skin types I-VI, were treated on their backs with a picosecond Alexandrite laser with a diffractive lens array, as well as a picosecond Nd:YAG laser at 532 nm and 1,064 nm with a holographic optic. Photographs were taken 15 minutes and 24 hours after treatments. Punch biopsies were obtained at 24 hours and examined histologically. Results: Treatment with the picosecond Nd:YAG laser at both 532 nm and 1,064 nm with the holographic optic revealed erythema and small scatted areas of petechial hemorrhage areas immediately and in many cases at 24 hours after treatment. The 755 nm picosecond Alexandrite laser with diffractive lens array produced erythema immediately after treatment, which largely dissipated 24 hours later. Histologies revealed intra-epidermal vacuoles with all three wavelengths. Fractional picosecond Nd:YAG laser at 532 nm and 1064 nm with the holographic optic showed focal areas of dermal and intra-epidermal hemorrhage with areas of vascular damage in some patients. Conclusions: This study demonstrates that both fractional picosecond devices produce vacuoles in the skin, which are most likely due to areas of laser induced optical breakdown (LIOB). In the patients (skin type II-IV) we observed scatter areas of hemorrhage in the skin, due to vascular damage with the 532 nm and 1,064 nm, but not with 755 nm wavelengths. Lasers Surg. Med. 50:37-44, 2018. © 2017 Wiley Periodicals, Inc.Key words: laser induced optical breakdown (LIOB); superficial hemorrhage; fractional picosecond laser; holographic optic; diffractive lens array INTRODUCTIONThe use of picosecond lasers with fractional optics have provided an opportunity to deliver high energy short pulses of light to the skin. The picosecond Alexandrite 755 nm laser with a diffractive lens array has been used successfully to treat acne scars [1], photo-damaged skin [2], and melasma [3]. We have described the creation of intraepidermal vacuoles, which appear to be the result of areas of LIOBs from the absorption of high energy 755 nm laser light by melanin in the granular layer of the epidermis [4]. This localized damage has been associated with the production of new collagen and elastic tissue. It is possible that the production of epidermally generated growth factors, cytokines, and chemokines could be responsible for these changes [1,5]. The immediate clinical effects of transient erythema, heat, and swelling with this device lasting less than 24 hours has been well characterized [5]. In individuals with skin types I and II with melanin index (MI) of 12 or less we ha...

BackgroundTreatment for both facial and truncal acne has not sufficiently been studied.ObjectivesTo evaluate the long‐term safety and efficacy of trifarotene in both facial and truncal acne.MethodsIn a multicentre, open‐label, 52‐week study, patients with moderate facial and truncal acne received trifarotene 50 μg/g cream (trifarotene). Assessments included local tolerability, safety, investigator and physician's global assessments (IGA, PGA) and quality of life (QOL). A validated QOL questionnaire was completed by the patient at Baseline, Week 12, 26 and 52/ET.ResultsOf 453 patients enrolled, 342 (75.5%) completed the study. Trifarotene‐related treatment‐emergent adverse events (TEAEs) were reported in 12.6% of patients, and none was serious. Most related TEAEs were cutaneous and occurred during the first 3 months. Signs and symptoms of local tolerability were mostly mild or moderate and severe signs, and symptoms were reported for 2.2% to 7.1% of patients for the face and 2.5% to 5.4% for the trunk. Local irritation increased during the first week of treatment on the face and up to Weeks 2 to 4 on the trunk with both decreasing thereafter.At Week 12, IGA and PGA success rates were 26.6% and 38.6%, respectively. Success rates increased to 65.1% and 66.9%, respectively at Week 52. Overall success (both IGA and PGA success in the same patient) was 57.9% at Week 52.At Week 52 visit, 92/171 (53.8%) patients who had completed their assessments had scores from 0 to 1 (i.e. no effect of acne on their QOL) vs. 47/208 (22.6%) patients at Baseline visit.ConclusionIn this 52‐week study, trifarotene was safe, well tolerated and effective in moderate facial and truncal acne.

Background and Objective: Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed. Methods: Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes. Results: Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre-and post-operative photos are presented. Conclusion: This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.